Headache/ Migraine

The definition of headache in Chinese medicine and western medicine are completely different:

In western medicine, headache, also known as cephalalgia, is the symptom of pain anywhere in the region of the head or neck. It occurs in migraines, tension-type headaches, and cluster headaches. Frequent headaches can affect relationships and employment. There is also an increased risk of depression in those with severe headaches.

Migraine: it is a recurrent throbbing headache that typically affects one side of the head and is often accompanied by nausea and disturbed vision.

• Moderate to severe pain (often described as pounding, throbbing pain) that can affect the whole head, or can shift from one side of the head to the other
• Sensitivity to light, noise or odors
• Blurred vision
• Nausea or vomiting, stomach upset, abdominal pain
• Loss of appetite
• Sensations of being very warm or cold
• Paleness
• Fatigue
• Dizziness
• Fever (rare)
• Bright flashing dots or lights, blind spots, wavy or jagged lines (aura)

Tension headache: it is the most common type of headache. It can cause mild, moderate, or intense pain in your head, neck, and behind your eyes. Some patients say that a tension headache feels like a tight band around their forehead.

Cluster headaches: it occur in cyclical patterns or clusters, are one of the most painful types of headache. A cluster headache commonly awakens you in the middle of the night with intense pain in or around one eye on one side of your head. Bouts of frequent attacks, known as cluster periods, can last from weeks to months, usually followed by remission periods when the headaches stop. During remission, no headaches occur for months and sometimes even years.Fortunately, cluster headache is rare and not life-threatening. Treatments can make cluster headache attacks shorter and less severe. In addition, medications can reduce the number of cluster headaches.

Medication-overuse headache: a secondary disorder caused by excessive use of acute medications. It has been previously termed analgesic rebound headaches, drug-induced headache, and medication misuse headaches. It is defined by the ICDH-3 diagnostic criteria as headache occurring on 15 or more days per month in a patient with a preexisting headache disorder who has been overusing one or more acute treatment drugs for symptomatic treatment of headache for three or more months, and those headaches cannot be accounted for by another diagnosis. MOH is more common in middle-life and the prevalence rages from 1% to 2% with a 2:1 female to male ratio. 3 people with higher frequency of headaches and greater disability have increased risk of developing chronic migraine.

In Chinese Medicine, there are eleven patterns of internal disease headache:

1. Binding depression of liver Qi pattern

The headache generally occurs on one side or in the area of the eyebrow bone and increases or diminished with change in the affects. Accompanying signs of liver lacking coursing and draining are generally emotional depression, a tendency of easily angered, chest oppression, a predilection for sighing, distention and pain of the chest and rib-side area, a string-like pulse, etc.

2. Liver fire flaming upward pattern

The headache is gradually distending and painful, with more severe pain on the vertex. Generally it is accompany with signs of liver fire raising counterflow such as dizziness, insomnia, red eyes, ringing in the ear, rashness, impatience and irascibility, and burning pain of the lateral costal area. In addition, there may be images of fire heat repletion such as constipation, reddish urine, a red tongue with yellow fur and a string-like and rapid pulse.

3. Ascendant hyperactivity of liver yang pattern

Here the headache is distending and is generally accompanied by manifestations of water failing to moisten wood such as dizziness, ringing in the ears, red cheeks and red eyes, insomnia, frequent dreaming, vexing heat of the five hearts, soreness and weakness of the lumbus, a red-purple tongue with little fur and a string-like, fine and rapid pulse.
4. Kidney essence insufficiency pattern
Here the headache generally manifests as pain with an emptiness inside the head. It is generally accompanied by signs such as soreness and weakness of the lumbus and knees, forgetfulness and abstraction, a devitalized essence-spirit, hair desertion or early grayling of the hair, loose teeth that easily fall out, seminal efflux, early emission or clear, thin vaginal discharge.

5. Blood vacuity pattern

Here the severity of the headache is relatively mild and the pain is dull. It is accompanied by manifestations of blood vacuity such as dizziness that is more severe than the pain, as well as a pale complexion without luster, or a withered yellow complexion, pale lips and nails, heart palpitations, insomnia, numbness of the limbs, etc.

6. Yin vacuity pattern (internal vacuity heat pattern)

Here the headache is generally a dull pain, there is emptiness and pain, and sometimes there is distending pain, but it is mild. This must be accompanied by such signs of in not linking with yang and internally generated heat as tidal fever, night sweating, vexing heat of the five hearts, emaciation, a purple tongue with little fur and a fine and rapid pulse. In addition, it may often be accompanied by five viscera yin essence depletion signs such as heart palpitations, insomnia, forgetfulness, dry cough and hoarseness, dizziness, ear ringing and pain of the waist and knees.

7. Qi vacuity pattern

Here the headache is generally mild, and is induced or made worse by taxation fatigue or standing for a long time. It must be accompanied by signs such as a pale white complexion, dizziness, shortness of breath and laziness in speaking, spirit fatigue and a lack of strength, spontaneous sweating that becomes worse on exertion, a pale and enlarged tongue with white fur and vacuous pulse. In addition, it is often accompanied by signs of insufficiency of the functions of the five viscera such as heart palpitations, torpid intake, abdominal distention and sloppy stools, a panting cough, a low voice and susceptibility to contraction of external evils.

8. Yang vacuity pattern (internal vacuity cold pattern)

Here the headache is generally mild or there is cold pain. It must be accompanied by images of vacuity cold such as fear of cold, cold limbs, pale or dusky complexion, a withered essence-spirit, a pale or dark purple and render tongue and a deep and slow or fine and weak pulse. In addition, there may be signs of unsettling of the yang qi of the viscera sign as heat palpitations, pain in the heart and chest, torpid intake, abdominal cold and pain and sloppy stools, or ringing ears and cold soreness of the lumbus and knees.

9. Phlegm turbidity headache pattern

Here there is headache and clouding dizziness. This must be accompanied by signs of phlegm turbidity obstructing the clear yang such as fullness and oppression of the chest and stomach duct, vomiting phlegm-rheum, heaviness fatigue of the body and limbs, slimy white tongue fur and a string-like and slippery pulse. If the headache is relatively severe, the dizziness is relatively severe, the eyes are tightly shut and there is no desire to open them, there is vomiting of phlegm-rheum and, in severe cases convulsions of the limbs and body, this indicates a wind-phlegm headache pattern due to wine-phlegm rising upward and phlegm turbidity stirring wind. If there is headache, ringing in the brain, or one-sided headache accompanied by fullness and oppression in the chest and stomach duct, and spitting of phlegm-rheum as well as manifestations of liver fire flaming upward, this is a phlegm-fire headache pattern due to phlegm depression transforming into fire and fire stirring the liver yang. If the headache feels as if the head were breaking, there is dizziness and nausea, spitting of phlegm-rheum and these are accompanied by unsettled heart-spirit, topsy-turvy speech and reversal cold of the four limbs, this indicates a phlegm reversal headache pattern due to phlegm turbidity rising counterflow and blocking the clear orifices.

10. Blood stasis headache pattern

Here there is generally a stabbing pain in one, fixed location that continues for a long time and does not subside. Often this is accompanied by signs of blood stasis obstructing the networks such as a dark complexion, dusky purple lips, a dusky purple tongue or stasis macules and stasis dots on the tongue, and a string-like and rough or fine and rough pulse.

11. Head wind pattern

The characteristics of this pattern are a relatively severe headache that comes and goes and lasts for a long time, accompanied by eye pain, and even loss of vision, dripping of foul-smelling nasal mucus, nausea, dizziness and ringing in the ears, numbness of the head or rigidity of the neck. This pattern is marked by severe disease circumstances and a long history of disease. If the original symptom is one-sided headache, this is called 'one-sided head wind.' If there is pain at tai yang point on both sides and even the brain hurts, this is called 'brain-squeezing wind.' If there is cold and unbearable pain around nao hu (Brain's Door, GV-17) and there is fear of cold on the nape of the neck and back, this is called 'brain wind.' In addition to these patterns, headache may be due to food stagnation; this is called 'food damage headache pattern.' It may be due to excessive drink king of alcohol; this is called 'alcohol damage headache.' There also is headache that is like thunder, with nodules arising on the head and face or swelling, pain and redness; this is called 'thunder head wind.'